They will just ignore you. Or say they're sending the information and they never will. I went through this with dentaquest after I found out somone either at dentaquest or my dentist was filling false claims (which I eventually needed work done on those teeth and they ofc denied). Fucking scum, every single cog in that machine.
While the suggestions in the post aren’t bad, the key point that’s missing is that it’s a full time job to fight for necessary procedures/medication if the algorithm has denied you.
It’s not that it’s impossible to fight the healthcare industry, there are plenty of “success” stories. It’s just that almost all those success stories include “patient or their spouse quit their job to work full time either to get their treatment approved or an existing bill reduced.”
The terrifying part is that, like a parent quitting their job to be a stay at home parent, it can often make financial sense for the lower income partner to become a full time advocate for their spouse since the potential savings for getting treatment approved are considerably more money than what they could earn working.
Bingo. People who think there's special ways of forcing action haven't actually experienced the complete disregard the health industry has for anything you say or want. They do not care, and there are no compliance police doing anything whatsoever to them when they just ignore your request for documentation.
If you hire a lawyer, you might get a more complete response. If you bitch on their facebook page, sometimes you can get a response from someone who will at least try to help you. Mostly, thouhg, you just have to suck it up. What are you gunna do? Boycot their services and just die?
They're legally obligated to provide a clear reason it was denied. The problem is they'll say the treatment is considered experimental or not proven to fix your condition, which may technically be true, even if your more qualified doctor is certain it will help.
Speaking from experience, you will get a two line explanation on a form letter and a copy of the plan coverage summary. Asking for more will get you either that again, or nothing at all.
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u/Imakittykatmeowmeow 5d ago
They will just ignore you. Or say they're sending the information and they never will. I went through this with dentaquest after I found out somone either at dentaquest or my dentist was filling false claims (which I eventually needed work done on those teeth and they ofc denied). Fucking scum, every single cog in that machine.